中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

远隔缺血时处理对体外循环瓣膜置换术患者炎性反应和氧化应激的影响

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目的 评价远隔缺血时处理对体外循环(cardiopulmonary bypass,CPB)心脏瓣膜置换术患者围术期炎性反应和氧化应激的影响。 方法 选择择期 CPB 下心脏瓣膜置换术患者 60 例,其中男 29 例、女 31 例,年龄 40~60 岁,体质量 45~70 kg,美国麻醉协会(American Society of Anesthesiologists,ASA)麻醉分级Ⅱ或Ⅲ级。采用随机数字表法,将患者分为 2 组(n=30):对照组(C 组,男 14 例、女 16 例)和远隔缺血时处理组(R 组,男 15 例、女 15 例)。R 组于主动脉阻断后同时对患者右下肢实施 3 周期 5 min 缺血/5 min 再灌注处理。于 CPB 前、CPB 结束后即刻、1、6 、24 h(T0-4)时取右颈内静脉血样,检测白介素(interleukin,IL)IL-6、IL-10、超氧化物歧化酶(Superoxide Dismutase, SOD)、丙二醛(Malondialdehyde,MDA)浓度,白细胞计数、单核细胞百分比,并测量患者膀胱温。于术前 1 d,术后 1 d、2 d、3 d 评估患者全身炎性反应综合征(systemic inflammatory response syndrome,SIRS)评分。记录拔管时间和住 ICU 时间。 结果 与 C 组比较,R 组 T1~T3 时血清 IL-6 浓度降低,T2~T3 时 SOD 血清 IL-10 浓度升高,T1~T2 时活性升高,T1 时 MDA 浓度降低,T3 时白细胞计数降低,T3~T4 时单核细胞比例升高,T4 时膀胱温降低,术后 1 d 全身炎性反应综合征(SIRS)评分降低(P<0.05);R 组拔管时间和 ICU 停留时间短于 C 组(P<0.05)。 结论 远隔缺血时处理可减轻 CPB 心脏瓣膜置换术患者炎性反应和氧化应激,促进患者恢复。

Objective To evaluate the effect of remote ischemic perconditioning on inflammation and oxidative stress in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods Sixty adult patients undergowent cardiac valve replacement under CPB. There were 29 males and 31 females with an age ranging from 40–60 years and weight from 45–70 kg. They were randomly divided into 2 groups (n=30 in each) by random number generator: a control group (group C, 14 males and 16 females) and a remote ischemic perconditioning group (group R, 15 males and 15 females). Anesthesia was induced with intravenous injection of midazolam, fentanyl, vecuronium. The patients were mechanically ventilated after endotracheal intubation. Anesthesia was maintained with intravenous injection of midazolam, fentanyl, vecuronium and inhalation of sevoflurane. Three cycles of 5-min ischemia and 5-min reperfusion were performed on the right lower extremity immediately after aortic occlusion by means of a tourniquet in group R. A tourniquet was only placed under the right lower extremity in group C. Before CPB and at 0, 1, 6 and 24 h after termination of CPB (T0-4), blood samples were obtained from the right internal jugular vein for determination of levels of serum IL-6, IL-10, SOD and MDA and the count of white blood cell and the percentage of monocytes. The bladder temperature was measured at T0-4 and SIRS score was evaluated on preoperative 1 d and postperative 1, 2 and 3 d. Tracheal extubation time and length of ICU stay were record. Results Compared with group C, the concentration of serum IL-6 at T1-3, the concentration of MDA at T1, the count of leukocyte T3, the bladder temperature at T4 and the SIRS scores on postperative 1 d were significantly decreased, while the concentration of serum IL-10 at T2-T3, the SOD activity at T1-T2, and the percentage of monocyte at T3-T4 were significantly increased in group R (P<0.05). Tracheal extubation time and length of ICU stay in group R were significantly shorter than those of group C (P<0.05). Conclusion Remote ischemic perconditioning can reduce inflammation and oxidative stress and improve post-operative recovery in patients undergoing cardiac valve replacement with CPB.

关键词: 体外循环; 远隔缺血时处理; 炎性反应; 氧化应激

Key words: Cardiopulmonary bypass; remote ischemic perconditioning; inflammation; oxidative stress

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